Laparoscopic Nissen Fundoplication

Laparoscopic Nissen fundoplication is a minimally invasive surgical procedure used to treat gastroesophageal reflux disease (GERD) and hiatal hernia. The procedure involves wrapping the upper portion of the stomach, known as the fundus, around the lower part of the esophagus to prevent stomach acid from flowing back up into the esophagus.

Indications

The laparoscopic Nissen fundoplication is typically recommended for patients who:

• Have severe GERD symptoms that do not respond to medical treatment
• Have a large hiatal hernia that requires repair
• Experience complications from GERD, such as esophagitis or stricture
• Are at risk of developing Barrett's esophagus or esophageal cancer due to chronic acid reflux

Surgical Procedure

The laparoscopic Nissen fundoplication is performed under general anesthesia. The surgeon makes several small incisions in the abdomen and inserts a laparoscope, which is a thin tube with a camera and light on the end. The laparoscope allows the surgeon to view the internal organs on a monitor.

The steps involved in the procedure are:

1. The stomach is lifted and the esophagus is identified
2. The upper portion of the stomach (fundus) is mobilized and wrapped around the lower part of the esophagus
3. The fundus is secured to the esophagus with sutures or staples
4. The hiatal hernia, if present, is repaired by closing the opening in the diaphragm
5. The stomach is returned to its normal position and the incisions are closed

Benefits

The laparoscopic Nissen fundoplication offers several benefits, including:

• Minimally invasive procedure with smaller incisions and less scarring
• Faster recovery time compared to open surgery
• Less post-operative pain and discomfort
• Reduced risk of complications, such as infection and adhesions
• High success rate in eliminating GERD symptoms

Risks and Complications

As with any surgical procedure, there are risks and potential complications associated with laparoscopic Nissen fundoplication, including:

• Bleeding or hemorrhage
• Infection or abscess
• Adhesions or bowel obstruction
• Dysphagia (difficulty swallowing)
• Gas-bloat syndrome
• Recurrence of GERD symptoms

Post-Operative Care

After the procedure, patients typically spend one to two days in the hospital for recovery and monitoring. The post-operative care instructions include:

• A liquid diet for several days to allow the stomach to heal
• A gradual progression to solid foods over several weeks
• Avoiding heavy lifting, bending, or strenuous activities for several weeks
• Taking medications as prescribed to manage pain and prevent complications
• Following up with the surgeon for post-operative check-ups and monitoring

Long-Term Results

The laparoscopic Nissen fundoplication has a high success rate in eliminating GERD symptoms and improving quality of life. Studies have shown that:

• 85-90% of patients experience significant improvement or complete resolution of GERD symptoms
• 70-80% of patients are able to stop taking anti-reflux medications after the procedure
• The procedure has a low recurrence rate, with most patients experiencing long-term relief from GERD symptoms